Chronic Disease

Heart failure has different causes in younger and older adults. For younger adults, it is hypertension, while in older adults, it is coronary artery disease. The heart failure hospital stay rate has declined nearly 30 percent over the past decade for Medicare beneficiaries. However, younger patients have not experienced the same comparable decline in hospital stay, according to a new study. Also, black men did not experience a significant decline in hospital stay, but black women, white men, and white women did.

Researchers analyzed data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. This is a large database containing information on acute hospital stays for all age groups and insurance coverage. The researchers looked at heart failure hospital stay rates, length of stay (LOS), and in-hospital mortality between 2001 and 2009. A total of 1,686,089 hospital stays for heart failure were identified from 29 States. More than half of the patients were age 75 and older. During the study period, the national heart failure stay rate decreased 26.9 percent.

Stay rate declines were most significant for patients age 55 to 64 (-36.5 percent), age 65 to 74 (-37.4 percent), and age 75 and up (-28.3 percent). However, no statistically significant changes in stay rates were found for patients age 18 to 44 (-12.8 percent) and for patients age 45 to 54 (-16.2 percent). Significant declines were observed for white women (-33.5 percent) and black women (-30.9 percent), but not for black men (-9.5 percent). White men had a decline of 24.7 percent. Overall, the average length of stay dropped from 5.6 days to 5.3 days, a 6.4 percent decline. Mortality also fell from 4.5 percent to 3.3 percent. Reductions in mortality were more significant for patients age 45 and older, but not for patients age 18 to 44. The study was supported in part by AHRQ (HS18781).